Sample Template

MTSS FSCP Implementation Guide
July 2016
Step Two: USE DATA TO CREATE MULTI-TIERED FSCP
ACTION PLANS (More About How)
Application Activity #1: Collect and Summarize Data
Data Summary
Sample Template
Team/Group/Organization/School and/or Names:
Date:
Directions: Please note assessment results of current family, school, and community (FSCP)
partnering practices. Data can be qualitative, numerical, existing or collected. Please note data
source and date. Then highlight relevant findings, noting possible actions that might support
effective practice. Use the data findings to create data-based, tiered action plan for a team or
group or organization or school.
Data Source
Date
Relevant Findings
Priorities and Possible
Actions
Strengths:
Concerns:
Strengths:
Concerns:
Strengths:
Concerns:
Strengths:
Concerns:
SUMMARY:
Response to Intervention (RtI) is incorporated within a Multi-Tiered System of Supports (MTSS)